I've been on a slow taper - over 2 years, I've gone from 6mg/daily down to 1mg/daily. My last step down, from 1.5mg to 1 mg, is the first time I've noticed what felt to me like withdrawal symptoms.

I've always taken my Sub first thing in the morning, once a day as recommended by my doc. A few weeks ago, when I dropped 0.5 to 1mg, I began having sleep issues. I was able to fall asleep but would awaken, typically around 2 or 3 AM, and be unable to fall back asleep.

One night, after many nights of this, it occurred to me that the anxious, unsettled feeling I was experiencing reminded me of withdrawal. It had been so long since I'd experienced w/d, it took a while for me to recognize it. I decided to take my Sub early (at 2AM vs 5AM, my usual time) and I fell back to sleep within 10 minutes. I slept soundly until my alarm went off at 5.

Since then, I've been taking my Sub at 9PM and am sleeping without any issues. I am not experiencing any identifiable w/d symptoms in the evening before I take it.

I have a basic understanding of Sub pharmacokinetics, I think, so I am confused as to what is actually happening. Is w/d possible 18 hours after a 1mg dose? Even if it is possible, would not that have dissipated (or at least, lessened) several weeks into the new lower dose of 1 mg?

have a basic understanding of Sub pharmacokinetics, I think, so I am confused as to what is actually happening. Is w/d possible 18 hours after a 1mg dose? Even if it is possible, would not that have dissipated (or at least, lessened) several weeks into the new lower dose of 1 mg?

Welcome to the forum!

Not a doctor or even close to an expert, but realize you're way below the ceiling effect and that a drop from 1.5. mg/s to 1 mg is a big reduction percentage wise. Or so it seems to me anyway. I don't think it's a surprise that you're edging into mild WD. I"d taper more slowly if these symptoms are too unpleasant...

Godfrey is correct imo. Once u get below the ceiling level, suboxone doesn't last as long as it did when u were above it. I've never been below the ceiling, so I can't speak from personal experience but that's definitely what's happening in ur case.

If taking ur dose at night is helping u feel more comfortable, then that's exactly what I'd keep doing. It's recommended to always do a slow taper, which is what u have been doing. There are some that takes 1mg as their maintenance dose every day, so they do finally adjust. I think ur body will adjust to 1mg too, it just may take a bit.

I agree with the other comments. Actually what surprised me is that you are doing relatively well, after a drop of 30% from an already-low dose. As mentioned above, people usually drop more slowly as the dose is lowered, and most people find it necessary to dose every 12 hours to reduce withdrawal symptoms.

Every now and then I will have a patient who experiences minimal withdrawal symptoms. I have no idea why some have it easier than others, but your experience reminds me of theirs. But again, the safest way to minimize or avoid withdrawal is to reduce by 5% per week-- an amount that is difficult to consistently measure with buprenorphine products. I usually recommend my patients change to the film when they get to 2 mg, since it is so much easier to divide than a 2 mg tablet.

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